Stressors that affect Nutrition NUR101 FALL 2008 LECTURE # 24 K. BURGER, MSED, MSN, RN, CNE PPP By...

Stressors that affect Nutrition

NUR101FALL 2008LECTURE # 24K. BURGER, MSED, MSN, RN, CNE

PPP BySharon Niggemeier RN MSNRevised 12/08 J Borrero

Nutrition• Nutrition is interaction between an

organism and the food it consumes• Food & eating is a basic need, affects

health• Various factors affect nutrition• Nutrients – substances used by the

body for growth & development• Role of nurse to teach, guide and

inform on the importance of proper nutrition

Nursing Assessment

• Dietary intake and food preparation

• Unpleasant symptoms

• Allergies

• Taste, chewing and swallowing

• Appetite and weight

• Use of medications

Nutritional health-care Team

• MD

• Nurse

• Social Worker

• Physical Therapist

• Occupational Therapist

• Speech Pathologist

• Pharmacist

Essential Nutrients Regulatory Nutrients

• Water

• Carbohydrates

• Proteins

• Lipids

• Vitamins

• Minerals

Water

• Water: present in every cell

• Absorbed in small /large intestine

• Metabolized carbohydrates, proteins, lipids produce water

• Dietary intake from fluids and solid food provide water

• Function: fluid medium needed for all chemical reactions in the body

Carbohydrates• Carbohydrates: simple or complex

• Digested by enzymes (amylase/lactase)

• Absorbed in small intestine

• Metabolized into glucose which is used for energy or stored…Stored as either glycogen or fat

• Function: provide energy, spare proteins

Carbohydrates (CHO)• Carbon – Hydrogen-Oxygen• 1 gram carbohydrate = 4 Kcal• Monosaccharides – simple sugars

glucose, fructose, galactose• Dissaccharides – double sugars

sucrose, lactose, maltose• Polysaccharides – complex forms

starch, glycogen, cellulose (fiber)• Recommended intake: 60% of total Kcal (300g)

Fiber 25-30g daily

Carbohydrates

• What are some other functions of carbohydrates in our bodies?

Laxative effects of:

LactoseCellulose

DIETARY FIBER - Helps regulate blood sugar

May reduce risk of hyperlipidemia

May reduce risk of some cancers

Protein• Proteins: composed of amino acids

• Digested by enzymes (proteolytic)

• Absorbed in small intestine

• Metabolism includes:

• Anabolism=Catabolism: Nitrogen balance

• Function: maintain body tissue and tissue growth

Protein (CHON)• Carbon-Hydrogen-Oxygen- Nitrogen• 1 gram of protein = 4 Kcal• Comprised of 22 amino acids which can be comined by

body to form over 1000 types of proteins• 9 essential amino acids – body cannot synthesize them• Complete protein = one with all 9 essential amino acids

(animal sources and soy)• Incomplete proteins = contain some but not all essential

(plant sources)• Complementary proteins = 2 proteins that when

combined provide all essential amino acids.• Recommended intake: 10% total Kcal ( 0.8g per 2.2lbs)

Proteins (CHON)

• What are some other functions of proteins?

Fluid Balance

Ex: Albumin

Energy ( last resort)De-amination / Nitrogen stripped from CHON to create glucose CHO

Lipids• Lipids: insoluble in water• Digested by enzymes (lipase,bile) in

stomach and small intestine• Absorbed in small intestine• Metabolism includes conversion (by

liver and small intestine) into soluble compounds called lipoproteins

• Function: energy, insulates body, absorption (fat-soluble vitamins)

Lipids (Fats)• Carbon-Hydrogen-Oxygen• 1 gram of Fat = 9 Kcal• Composed of fatty acids: (linoleic&linolenic =essential)

• Saturated fat = mostly animal source• Unsaturated fat = mostly plant and fish sources• Triglyceride = fat in bloodstream /storage form of fat

in body. • Trans Fat = hydrogenated fats in processed foods• Recommended intake: 20-35% of total Kcal

Lipids• Lipoproteins - made by the body to move water-

insoluble lipids (such as cholesterol) thru the bloodstream

• LDL (low density lipoprotein)- major carrier of cholesterol. Function is to transport cholesterol from liver into circulation. “Bad cholesterol”

• HDL (High density lipoprotein) - carries cholesterol away from tissue to liver ..high levels decrease atherosclerosis. “Good cholesterol”

• Cholesterol- not essential from diet as the body produces enough.

Desirable Blood Lipid Levels

• Total Cholesterol < 200• Triglycerides < 150• LDL < 100• HDL > 40 Male

> 50 Female• Elevated Blood Lipid Levels

(Hyperlipidemia) = increased risk for CHD, Hypertension, Stroke, MI

Vitamins• Vitamins: required in small amounts

• water- soluble: absorbed through intestine directly into blood stream (C, B complex folic acid)

• fat-soluble: absorbed with lipids into lymphatic circulation (A,D,E,K)

• Function: needed for metabolism of carbohydrates, lipids & proteins

Water-soluble vitamins text review

Vitamin C (ascorbic acid)

• Function: collagen formation (wound

healing), antioxidant, immune system

• More prone to deficiency; not stored

• Deficiency: bleeding gums, scurvy, poor wound healing

• Source: citrus fruits, tomatoes, broccoli

Vitamin B Complex : thiamine, riboflavin, niacin, B6, B12

• Function: metabolism of carbs, lipids and proteins

• RNA, DNA synthesis (folic acid) & heme formation (B12)

• Deficiency:beriberi, poor wound healing, anemia, pernicious anemia

• Sources: Whole grains Organ meats

Vitamin B12 (continued)

Vitamin B12 (cobalamine)• Important for hemoglobin synthesis• Very little found in vegetable sources (unlike other B Vitamins)

• Pernicious anemia = B12 deficiency or lack of intrinsic factor for B12 absorption.Susceptible population = Total VeganClients w/ decreased gastric acid secretion(gastric bypass, stomach cancer)

• Rx = B12 injections

Folic Acid

Folic Acid (Folate)

• Folic Acid Deficiency leads to elevated Homocysteine levels which are associated with increased risk for CHD.

• Folic Acid Deficiency linked to neural tube defects – Spina Bifida

• Natural folate (in foods) only ½ as available to body as supplement folic acid

• 1998 = mandatory fortification of breads/grains• Supplements recommended for: women of child-bearing

age, gastric surgery, malabsorption (alcholic)

Fat-soluble Vitamins text review• Vitamin A: function- visual acuity, skin maintenance…

deficiency-night blindnessDark green leafy vegs, yellow/orange vegs

• Vitamin D: function-calcium absorption… deficiency-rickets, bone malformationFortified milk, ultraviolet light

• Vitamin E: function-antioxidant, heme synthesis…deficiency-RBC hemolysisWhole grains, nuts

• Vitamin K: function-formation blood clotting proteins…deficiency- hemorrhageDark green leafy vegs, synthesized by bacteria in sm intestine

• More prone to toxicity; stored by body

Minerals• Minerals: macrominerals or microminerals

• Originate in earth’s crust, aren’t digested or metabolized. Combine to form salts or organic compounds. Always retain their chemical properties.

• Function: provide structure within the body (bones/teeth, F/E and acid /base balance, nerve transmission, muscle contraction)

Macrominerals text review

• Calcium: bone/ teeth formation, blood clotting, nerve transmission…deficiency-tetany, osteoporosis

• Phosphorous: bones, acid-base balance…deficiency- muscle weakness

• Magnesium: bones, metabolism ...deficiency-muscle pain, poor cardiac function

• Potassium: f/e balance, acid-base balance…

deficiency-muscle cramps , irregular ht. rate

Microminerals text review

• Iron: hemoglobin formation…deficiency-anemia

• Iodine: thyroid hormones…deficiency- goiter

• Zinc: wound healing … deficiency-impaired immune system

• Fluoride: teeth/bones…deficiency- discolored tooth enamel

Energy Balance• Kilocalorie- unit of heat; measures the

energy in the diet• Basal metabolic rate (BMR)- amount

of energy needed for all the biochemical processes to occur when the body is at rest.

• Proper nutrition provides the energy needed to maintain health

Body Weight Standards• Ideal body

weight IBW = balance of energy used by the body and intake of nutrients

• Rule of thumbWomen: 100 lbs lst 5ft

5 lbs/inch over 5ftMen: 106 lbs lst 5 ft 6 lbs/inch over 5ft

• Standardized chartsOverweight = 10% > chartObese = 20% > chart

• Body mass index(BMI) 18.5 – 24.9 healthy> 25 = overweight> 30 = obese> 40 = morbidly obese

Calculate your BMI

Weight (lbs)

Height (inches) squared

X 705

Factors Affecting Nutrition• Developmental• Gender• Ethnicity &

culture• Food beliefs• Preference• Religion

Factors Affecting Nutrition• Lifestyle• Medications &

therapy• Heath status• Advertising• Alcohol

Consumption• Psychological

factors

Adequate Nutrition• Food Guide

Pyramid

• Daily reference intake

• Food Labeling

• Dietary guidelines

Dietary Guidelines

• Balance / Moderation / Variety

• Maintain healthy weight

• Exercise

• Eat a variety of foods in moderation

• Low sodium / Low fat / Low simple sugars

• Alcohol in moderation

Assessing: Nutrition• Nursing history • Physical exam• 24-hr. recall• Food records• Anthropometic data• Lab tests – Albumin & Prealbumin

Hemoglobin Transferrin

Nursing Dx• Imbalanced nutrition: less than body

requirements R/T NPO status AEB height 5’6’’ wt 105 lbs., pt. states “ I’ve never been this skinny before, my clothes are hanging off of me”

• Impaired dentition R/T nutritional deficits AEB dentures not fitting properly

Planning- outcome criteria• Pt. will:

• Attain and maintain ideal body weight

• Eat a variety of foods at each meal

• Promote healthy nutritional practices

Interventions

• Monitoring food intake

• Assist with feeding

• Stimulate appetite• Teaching

Diet Restrictions• NPO• Clear liquids-see

through (broth, apple juice)

• Full liquids –foods that turn to liquid at room temp. (shakes, milk)

• Soft –easily chewed and digested

• Low residue- no seeds, raw vegetables or fruits, whole grains

• High fiber- raw fruits, grains, vegetables

• Sodium restricted:– Mild 2 gram Na/day– Moderate 1gram– Strict 500mg– Severe 250 mg– DASH Dietary Approaches

to Stop Hypertension

Diet Restrictions

• Calorie restrictions

• Diabetic diet

• Cholesterol

• Food textures:Thick it

• Thin

• Nectar-like

• Honey-like

• Spoon-thick

Enteral Nutrition

• Used when oral intake is inadequate, swallowing difficulty, coma

• Tube passed into gastrointestinal tract to deliver nutrients

• Maintains GI integrity preferred over parental feedings (via veins)

Enteral Nutrition

• Short term use

• Nasogastric

• Nasointestinal

• Long term use

• Gastrostomy• Percutaneous

endoscopic gastrostromy (PEG)

Enteral Formulas

• Many types of formulas

• Administered continuous or intermittent

• Use pumps to monitor intake

• Monitor Intake & Output

Enteral Precautions

• Prevent aspiration– Position fowlers/high fowlers

– Assess placement…check pH

– Note residual

– Auscultate bowel sounds

Enteral Precautions

• Preventing complications include:

• Clogged tube• Nasal erosion• Diarrhea• Infection• Dislodgement

Parental Nutrition

• Bypasses GI tract, nutrition administered IV, more complicated

• Total parental nutrition (TPN) also called (hyperalimentation)…central line

• Partial parental nutrition (PPN)..PICC line

Evaluation

• Use established outcomes to evaluate the pt’s response to care

• Pt understanding of therapeutic diet

• Reassess S&S associated with altered nutrition (wt, intake, lab results)

• Determine pt’s satisfaction with nutritional therapy

Summary• Nurses role, to understand nutrients and

how they affect nutrition• Various factors affect one’s nutritional

status• Interventions include numerous diets,

assisting with feeding, monitoring and teaching

• Nutrition can also be administered enterally or parentally